Endometriosis is a chronic, inflammatory condition that occurs when tissue similar to the inner lining of the uterus grows outside of the uterus — like on the fallopian tubes and the bladder, amongst other places. Sometimes, this tissue can get in the way during sex, making it nearly impossible to enjoy.
If there's tissue present behind the vagina or tissue between the vagina and the front of the rectum, for example, penetration and other intimate movements can stretch or pull it, resulting in immense pain. Vaginal dryness, which may be caused by hormone treatment or hysterectomy (two common ways OB-GYNs address endometriosis) can also cause pain.
"The pain and scarring associated with endometriosis can make a woman's pelvis feel 'contracted' and tense at all times," says Lucky Sekhon, MD, a reproductive endocrinologist and infertility specialist at RMANY, an NYC-based IVF center. "Deep infiltrative lesions can lead to a condition called dyspareunia, which is characterized by intense pain with vaginal penetration. For [folks] with milder forms of endometriosis or endometriosis that does not impact the deep or lower pelvis, sex may feel less painful."
The good news is that there are tips and tricks to getting around the pain and gaining control of your sex life. In this article, we'll discuss sex positions and endometriosis-friendly practices that may help the next time you're feeling intimate.
Best sex position when you have endometriosis
While endometriosis is an individualised condition, positions that allow shallow penetration tend to be more pleasurable. Here are five of the best sex positions a person with endometriosis should try.
Woman on top. This is basically the missionary position, except the female is on top. "Being on top allows you to be in control of the pace and degree of vaginal penetration," says Sekhon. Plus, being on top may give you more direct access to the clitoris, which may help you experience more pleasure.
Reverse cowgirl. In this position, you're on top but instead of being face to face with your partner, you're facing their feet. Because you're still on top, you can control the depth, speed, and intensity that works best for you. The angle of penetration may avoid some trigger spots.
Sideways. For some, the "doggy style" position can be excruciating because it allows to deeper penetration. But that doesn't mean you can't enjoy other from-behind positions. The sideways sex position (sometimes called the "snuggly spoon,") can work both ways: You can choose to be face-to-face with your partner or you can spoon. Since you can be the one doing the thrusting, you can control the depth of penetration.
Modified doggy style. If the classic doggy style position is too painful for enjoyment, modify it! Instead of being on your knees, try lying on your stomach (you can also add pillows if you need to). Have your partner lay on top and enter you with a hand, toy, dildo, or penis. The modified version of this position also allows for intimacy. Your partner can easily kiss your neck or back or hold your hands in this position.
Lotus. This is an intimate sex position. To achieve the lotus position, ask your partner to sit cross-legged on the bed, floor, or wherever they're most comfortable.Then, sitting face-to-face, straddle them so that you're both chest-to-chest. You can also wrap your legs around your partner if you're comfortable enough to do so. This position allows your partner to rock you, rather than thrusting upwards.
How to maintain a healthy sex life when you have endometriosis
Switching positions isn't the only way to reduce pain during sex. Here are five tips you and a partner can try to help manage the pain.
- Non-penetrative sex. Sex with another person is uniquely co-created to be mutually pleasurable for all involved. "When penetration isn't seen as the main course that everything else is leading up to, the sexual menu opens up and there's so much more room for pleasure without feeling guilty that it doesn't include penetration," says Emily Sauer, founder of the Ohnut, the first intimate wearable that allows users to adjust the depth of penetration. "One great way to try this is to take orgasm off the table. Explore without a definitive goal. Maybe that's some earlobe rubbing, and that's the extent of it. Maybe it's dry humping like a couple of high schoolers (don't knock it till you try it)." Many people find their nipples, necks, and ears quite arousing, possibly even orgasmic.
- Use toys. Adding toys, such as a clitoral sucking vibrator, is a fun way to get the night started. The Ohnut, mentioned above, isn't exactly a toy, but it can be used as such. As the name suggests, the Ohnut is an intimate wearable that's shaped like a donut. With a lot of lube and a little bit of creativity, this little donut can be used in foreplay and is designed to make sex more enjoyable for folkswho experience dyspareunia, also known as pelvic pain, with penetration.
- Use a lubricant. Vaginal dryness is an issue for many and can show up unexpectedly for a variety of reasons, including hormone treatment, stress, a hysterectomy, etc. Finding a good premium quality lubricant can help alleviate any discomfort.
- Take an anti-inflammatory or pain reliever at least one hour prior to sex. Taking Advil or Tylenol prior to sex may alleviate pain during sex or, better yet, invest in cannabinoid-infused suppositories. While there's still research to be done on the effects of CBD, suppositories can help alleviate pain (and even increase pleasure) during sex. Use condoms or other barriers if your partner doesn't intend to come in to contact with medicated creams or lubes. If you're working with a pelvic pain specialist, they may prescribe other suppositories or lubes.
- Keep a pain diary. Keeping a pain diary can help you gauge when and what is causing or making your pain worse. Jot down specific entries including what you ate, whether you were stressed, or if you're menstruating. This way, you'll have a detailed log for future reference. "If you notice there are certain times of the month that are worse than others, endometriosis symptom-wise, you may want to avoid sex during that time," says Sekhon.
If you have a partner who has endometriosis, it's important to have an open conversation about it and to ask your partner how they're feeling before, during, and after sex. Don't make it clinical, just genuinely ask them how they're feeling.
"It's important to be open and honest with your partner to avoid misunderstandings or undue feelings of rejection in cases where they initiate sex and the person with endometriosis cannot reciprocate [with penetrative sex] due to pain," says Sekhon.
To help normalize the conversation about endometriosis and to learn more about how it can impact your sex life, Sekhon recommends going to an OBGYN with your partner. Doing so will not only give you reassurance but it will also help your partner feel validated and heard. A pelvic pain specialist will also be able to aid in helping you or your partner in dealing with endometriosis. They can also provide some tailored recommendations for more enjoyable sex.
Endometriosis doesn't have to ruin or end your sex life. By implementing a few of the tips above, whether you choose to switch positions, add a bit of foreplay, or do a combination of both, sex should become easier and more enjoyable for you and your partner both.
"It's OK to have a bad day and say no'" says Sekhon. "Don't push yourself to have sex if you're in a lot of pain or not in the mood. Otherwise, it can become a chore and associated with your endometriosis rather than a pleasurable act."
This article was medically reviewed by Rosara Torrisi, LCSW, CST, MSSW, MEd, PhD, a certified sex therapist at the Long Island Institute of Sex Therapy.